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How Citalopram Works to Treat Depression and Anxiety Other Antidepressants: Which is Right for You?

Citalopram

An Important Warning for you

A small number of children, teenagers, and young adults (up to 24 years of age) who took antidepressants (‘mood elevators’) such as citalopram during clinical studies became suicidal (thinking about harming or killing oneself or planning or trying to do so). Children, teenagers, and young adults who take antidepressants to treat depression or other mental illnesses may be more likely to become suicidal than children, teenagers, and young adults who do not take antidepressants to treat these conditions. However, experts are unsure about this risk’s significance and how much it should be considered in deciding whether a child or teenager should take an antidepressant. Children younger than 18 should not usually take citalopram, but in some cases, a doctor may determine that citalopram is the best medication to treat a child’s condition.

You should know that your mental health may change unexpectedly when you take citalopram or other antidepressants, even if you are an adult over 24. may become suicidal, especially at the beginning of your treatment and any time that your dose is increased or decreased. You, your family, or your caregiver should call your doctor right away if you experience any of the following symptoms: new or worsening depression; thinking about harming or killing yourself or planning or trying to do so; extreme worry; agitation; panic attacks; difficulty falling asleep or staying asleep; aggressive behavior; irritability; acting without thinking; severe restlessness; and frenzied abnormal excitement. Ensure your family or caregiver knows which symptoms may be painful so they can call the doctor if you cannot seek treatment alone.

Your healthcare provider will want to see you often while taking citalopram, especially at the beginning of your treatment. Be sure to keep all appointments for office visits with your doctor.

The doctor or pharmacist will give you the manufacturer’s patient information sheet (Medication Guide) when you begin treatment with citalopram. Read the information carefully and ask your doctor or pharmacist if you have any questions. You also can obtain the Medication Guide from the F.D.A. website: http://www.fda.gov/Drugs/DrugSafety/ucm085729.htm.

No matter your age, before you take an antidepressant, you, your parent, or your caregiver should talk to your doctor about the risks and benefits of treating your condition with an antidepressant or with other treatments. It would help if you also discussed the risks and benefits of not treating your disease. You should know that having depression or another mental illness significantly increases the chance that you will become suicidal. This risk is higher if you or anyone in your family has or has ever had bipolar disorder (mood that changes from depressed to abnormally excited) or mania (frenzied, abnormally excited mood) or has thought about or attempted suicide. Talk to your doctor about your condition, symptoms, and medical history. You and your doctor will decide what treatment is proper for you.

Why Your Doctor Chose This Medication for Your Condition

Citalopram is used to treat depression. Citalopram is in a class of antidepressants called selective serotonin reuptake inhibitors (SSRIs). It works by increasing the amount of serotonin, a natural substance in the brain that helps maintain mental balance.

How should this medicine be used?

Citalopram is a tablet and a solution (liquid) to take by mouth. It is usually taken once daily, in the morning or evening, with or without food. Take citalopram at around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take citalopram exactly as directed. Please only take what your doctor prescribes.

Your doctor may start you on a low dose of citalopram and gradually increase your amount, not more often than once a week.

It may take 1 to 4 weeks before you notice the full benefit of citalopram. Continue to take citalopram even if you feel well. Do not stop taking citalopram without talking to your doctor. Your doctor will probably decrease your dose gradually. If you suddenly stop taking citalopram, you may experience withdrawal symptoms such as mood changes, irritability, agitation, dizziness, numbness, tingling or electric shock-like sensations in the hands or feet, anxiety, confusion, headache, tiredness, nausea, sweating, shaking, frenzied or abnormally excited mood, and difficulty falling asleep or staying asleep. Tell your doctor if you experience any of these symptoms while decreasing your dose of citalopram or soon after you stop taking citalopram.

Other uses for this medicine

Citalopram is also sometimes used to treat obsessive-compulsive disorder (bothersome thoughts that won’t go away and the need to perform specific actions over and over), eating disorders, alcoholism, panic disorder (a condition that causes sudden attacks of extreme fear with no apparent cause), premenstrual dysphoric disorder (a group of physical and emotional symptoms that occur before the menstrual period each month), social anxiety disorder (extreme fear of interacting with others or performing in front of others that interferes with everyday life), posttraumatic stress disorder, tingling in the hands and feet caused by diabetes, and specific male sexual problems. Talk to your doctor about the possible risks of using this medication for your condition.

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

What special precautions should I follow?

Before taking citalopram,

  • Tell your doctor and pharmacist if you are allergic to citalopram, escitalopram (Lexapro), any other medications, or any of the ingredients in the citalopram product you are taking. Talk to your pharmacist or check the Medication Guide for a list of the ingredients.
  • Tell your doctor if you are taking pimozide (Orap) or a monoamine oxidase (M.A.O.) inhibitor such as isocarboxazid (Marplan), linezolid (Zyvox), methylene blue, phenelzine (Nardil), selegiline (Emsam, Zelapar), or tranylcypromine (Parnate), or if you have stopped taking an M.A.O. inhibitor within the past 14 days. Your doctor will probably tell you not to take citalopram. If you stop taking citalopram, you should wait at least 14 days before you start to take an M.A.O. inhibitor.
  • You should know that citalopram is similar to another SSRI, escitalopram (Lexapro). You should not take these two medications together.
  • Tell your doctor and pharmacist what other prescription and nonprescription medications and vitamins you plan to take. Be sure to mention any of the following: amiodarone (Nexterone, Pacerone); amphetamines such as amphetamine (in Adderall, in Mydayis), dextroamphetamine (Dexedrine, in Adderall), and methamphetamine (Desoxyn); anticoagulants (‘blood thinners’) such as warfarin (Coumadin, Jantoven); aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn); carbamazepine (Carbatrol, Equetro, Tegretol, others); chlorpromazine; cimetidine (Tagamet); diuretics (‘water pills); disopyramide (Norpace); dofetilide (Tikosyn); erythromycin (E.E.S. Ery-Tab, Erythrocin); fentanyl (Actiq, Duragesic, Fentora, Subsys); lithium (Lithobid); medications for anxiety, chronic pain, mental illness, and seizures; medications for migraine headaches such as almotriptan, eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Imitrex, Tosymra, in Treximet), and zolmitriptan (Zomig); methadone (Methadose); metoprolol (Lopressor, Toprol XL); moxifloxacin; omeprazole (Prilosec, Zegerid); pentamidine (Nebupent, Pentam); other SSRIs such as fluoxetine (Prozac, in Symbyax), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft); serotonin–norepinephrine reuptake inhibitors (SNRIs) such as duloxetine (Cymbalta); procainamide; quinidine (in Nuedexta); sedatives; sleeping pills; sotalol (Betapace, Sorine, Sotylize); thioridazine (Mellaril); tramadol (Conzip, Qdolo, Ultram, in Ultracet); tranquilizers; and tricyclic antidepressants such as amitriptyline, amoxapine, clomipramine (Anafranil), desipramine (Norpramin), doxepin (Silenor), imipramine (Tofranil), nortriptyline (Pamelor), protriptyline, and trimipramine. Your doctor may need to change the doses of your medications or monitor you carefully for side effects. Many other medicines may also interact with citalopram, so tell your doctor about all your prescriptions, even those that do not appear on this list.
  • Tell your doctor what nutritional supplements and herbal products you take, especially those containing St. John’s wort or tryptophan.
  • Tell your doctor if you drink or have ever drunk large amounts of alcohol or use or have ever used street drugs, or have ever overused prescription medications. Also, tell your doctor if you or anyone in your family has or has ever had long Q.T. syndrome (a rare heart problem that may cause irregular heartbeat, fainting, or sudden death), if you have recently had a heart attack, or if you have or have ever had a slow or irregular heartbeat, heart failure (a condition in which the heart cannot pump enough blood to other parts of the body) or other heart conditions; high blood pressure; bleeding problems; stroke; low levels of magnesium, potassium, or sodium in your blood; seizures; or kidney or liver disease.
  • Tell your doctor if you are pregnant, especially in the last few months, or if you plan to become pregnant or are breastfeeding. If you become pregnant while taking citalopram, call your doctor. Citalopram may cause problems in newborns following delivery if taken during the last months of pregnancy.
  • You should know that citalopram may make you drowsy and may affect your judgment, thinking, and movements. Do not drive a car or operate machinery until you know how this medication affects you.
  • Talk to your doctor about the safe use of alcoholic beverages during your treatment with citalopram. Alcohol can make the side effects of citalopram worse.
  • You should know that citalopram may cause angle-closure glaucoma (a condition where the fluid is suddenly blocked and unable to flow out of the eye, causing a quick, severe increase in eye pressure which may lead to a loss of vision). Talk to your doctor about having an eye examination before taking this medication. If you have nausea, eye pain, changes in vision, such as seeing colored rings around lights, and swelling or redness in or around the eye, call your doctor or get emergency medical treatment right away.

What special dietary instructions should I follow?

Unless your doctor tells you otherwise, continue your regular diet.

What should I do if I forget a dose?

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double amount to make up for a missed one.

What side effects can this medication cause?

Citalopram may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

  • nausea
  • diarrhea
  • constipation
  • vomiting
  • stomach pain
  • heartburn
  • decreased appetite
  • weight loss
  • increased sweating
  • increased thirst
  • frequent urination
  • difficulty falling asleep or staying asleep
  • drowsiness
  • excessive tiredness
  • yawning
  • weakness
  • uncontrollable shaking of a part of the body
  • muscle or joint pain
  • dry mouth
  • sexual problems in males; decreased sex drive, inability to get or keep an erection, or delayed or absent ejaculation
  • sexual problems in females; decreased sex drive, delayed orgasm, or failure to have an orgasm
  • heavy menstrual periods
  • runny nose

Some side effects can be severe. If you experience any of the following symptoms, or those listed in the IMPORTANT WARNING or SPECIAL PRECAUTIONS sections, call your doctor immediately or get emergency medical treatment:

  • chest pain
  • shortness of breath
  • dizziness
  • fainting
  • fever, sweating, confusion, fast or irregular heartbeat, severe muscle stiffness or twitching, agitation, hallucinations, loss of coordination, nausea, vomiting, or diarrhea
  • coma (loss of consciousness)
  • hives or blisters
  • rash
  • itching
  • difficulty breathing or swallowing
  • swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
  • hoarseness
  • unusual bleeding or bruising
  • nose bleeding
  • headache
  • unsteadiness
  • problems with thinking, concentration, or memory
  • seizures

Citalopram may decrease appetite and cause weight loss in children. Your child’s doctor will oversee their growth. Talk to your child’s doctor if you have concerns about your child’s growth or weight while taking this medication. Talk to your child’s doctor about the risks of giving citalopram to your child.

Citalopram may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

If you experience a severe side effect, you or your doctor may send a report to the Food and Drug Administration’s (F.D.A.) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

What should I know about the storage and disposal of this medication?

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom).

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant, and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location that is up and away and out of their sight and reach. http://www.upandaway.org

Unneeded medications should be disposed of uniquely to ensure that pets, children, and others cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the F.D.A.’s Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you cannot access a take-back program.

In case of an emergency/overdose

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can’t be awakened, immediately call emergency services at 911.

Symptoms of overdose may include the following:

  • dizziness
  • sweating
  • nausea
  • vomiting
  • uncontrollable shaking of a part of the body
  • drowsiness
  • fast, irregular, or pounding heartbeat
  • memory loss
  • confusion
  • seizures
  • coma (loss of consciousness)
  • fast breathing
  • bluish color around the mouth, fingers, or fingernails
  • muscle pain
  • dark-colored urine

What other information should I know?

Keep all appointments with your doctor and the laboratory. Your doctor may order specific laboratory tests and electrocardiograms (EKG, a test to monitor your heart rate and rhythm) before you start taking citalopram and during your treatment with this medication.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

You need to keep a written list of all the prescription and nonprescription (over-the-counter) medicines you are taking and any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

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